The return to full service

When the committee met on September 7, it first dealt with Blanchard's comments on the interim report. The minutes concluded that the "risk level, although awkward to deal with, had assisted in resolving differences between members of the Cardiac Team." (Exhibit 20, Document 278 I) The minutes further stated that in the previous two weeks, two infants had undergone successful operations. Giddins noted that since the program had been partially suspended, three of the eleven patients who had been sent out of province had died. A survey of VCHC records indicates that, in fact, fourteen patients had been referred out of province during this period. One died within twenty-four hours of surgery, one died thirty-two days after surgery (twelve days after being initially discharged from hospital), and one died forty-one days after surgery (twenty-one days after being discharged).

Discussion occurred concerning the impact of sending patients away from the program in Winnipeg. It was felt that these patients constitute a significant part of the overall patient population and as such the local program is considerably weakened by their transfer. (Exhibit 20, Document 278 I)

Wiseman believed that the program was weakened because a reduction in the number of complex cases affected the development of the team's skills. McNeill did not believe the program had been weakened, if by that term one meant a decline in team members' skills by sending some patients out of the province. However, she did agree that the program was not providing the services originally intended. To that extent, she agreed, the program was weakened.

The meeting then went on to discuss the program's future.

Following discussion of this issue it was the consensus of the members of the committee that the program now continue at full capacity. Specifically, it is intended that patient selection for surgery will be the responsibility of the Cardiac Surgery and Cardiology Departments. It was recommended that discussion re: patients and review of patient management occur appropriately at the Friday end of month session which is intended to allow all members of the Team to participate fully. (Bold and italicized in original) (Exhibit 20, Document 278 I)

Wiseman testified that while the surgeon and the cardiologist would be selecting patients, other team members would have input into the selection process, when the recommendations were presented at the pre-operative conference.

Finally, it was recommended that Seshia be invited to attend the committee's next meeting to discuss post-operative care issues.

McNeill testified that, in agreeing to the return to full service, she was not simply responding to pressure. She said she felt that the surgical results over the summer had been positive, as were the few moderate-risk cases that had been undertaken. She said that, while relations with Giddins and Odim were not friendly, they were civil. However, she felt that the review had not accomplished all that had been hoped for.

I know, when we went into the process we had concerns about surgical technique, or the surgical side of the patient management that I didn't feel was addressed completely through the process. Whether it could have been or not, because by the nature of what we were doing and the way we were doing it, I am not sure that we really stood much chance of necessarily answering all the questions that we had at the beginning.

So, from my point of view, and also the other anaesthetists, because I spoke with them, we felt that was still a partially unresolved issue at the end of this.

Question: I know we have been over this before, but can you clarify as to why you couldn't get at that?

McNeill: In many ways because it came down often to non-surgeons commenting on surgical care. So, there is always, no matter, you know, how you approach it, you get to that bottom line. And there perhaps would have been a more likelihood of resolving issues if there had been a mechanism for other surgeons to examine the issue or comment. (Evidence, pages 13,371-13,372)

Wong testified that he thought it was a mistake to return to full service.

I didn't think that we had had enough time on the lower risk cases to really develop confidence for the team in each other again, and work together. And an example like what we just talked about [Wong was referring to the suturing of the eustachian valve in the KZ case] was one of the reasons that I had concerns. (Evidence, pages 19,914-19,915)

Wong was asked why he agreed to a return to the full program when he had these reservations.

Basically, the evidence had been presented to the administration aka the Wiseman committee and, you know, it was their judgment that it was safe to return. And it was out of our area of expertise to decide what was safe and what was unsafe, so we agreed, even though our reservations were not satisfied.

As well, we had agreed to abide with the findings of the committee, so we were, I guess you would say we were being team players, even though we weren't happy, everybody else said it was okay, so we reluctantly agreed. (Evidence, pages 19,915-19,916)

Throughout the period when the team was doing only low-risk cases, Youngson said that while the surgical outcomes had improved, there were still ongoing problems with cannulation. When testifying about the September 7 decision, she stated:

Well, I think we were all happy with the results over the summer for the most part. Things had gone fairly well. There had been a couple of things that had happened in the operating room, but for the most part, the outcomes had been what we had hoped for.

I think anaesthesia still had some reservations about going to a full program, and so did nursing. But at this point in time, I was not prepared to voice my opinion any more at these meetings. I just was there more or less as an observer later on in the year.

I really didn't feel that nursing concerns were considered important to-certainly to Dr. Odim and to Dr. Giddins. (Evidence, pages 8,572-8,573)

In this general state of dissatisfaction over the review process, the Pediatric Cardiac Surgery Program prepared to return to doing all cases.